Nowhere on the planet does the tobacco epidemic loom more ominously than in China, where there are 300 million smokers and where findings from the International Tobacco Control (ITC) China Project over the past five years have documented the very low levels of knowledge about the specific harms of cigarettes, relative to other ITC countries throughout the world.

The road map for reducing tobacco use is clearly described by the WHO Framework Convention on Tobacco Control (WHO FCTC), the world’s first health treaty. Among the key objectives of the treaty, which China ratified in 2005, is to inform consumers about the enormous health harms of cigarettes and other tobacco products – part of the WHO’s MPOWER package of FCTC policies, under the W (for “Warn”). The FCTC Article 11 Guidelines provide a clear description of the ingredients for strong and effective warnings: that they should occupy at least 50% of the front and back of the pack, that they should describe specific harms (e.g., lung cancer, heart disease, stroke, emphysema) that are known to be caused by cigarette smoking, and that they should include pictorial images of the harms of tobacco products in order to increase the salience of the warnings and to emotionally engage consumers.

Research studies over the past decade – including those from the ITC Project across many countries – have concluded that such pictorial warnings significantly increase effectiveness by increasing knowledge, awareness and perceptions of the risk of cigarettes, and that this leads to greater motivation and movement towards quitting among smokers and lowered motivation to start smoking among non-smokers. A recent ITC Project study has shown that the introduction of pictorial warnings in Canada led to a significant decline in smoking rates.

All of the research evidence demonstrating the power or pictorial warnings has so far not be incorporated in to health warnings in China. And as a result, it is not surprising that the findings presented in this report show that the current text-only Chinese health warnings are very ineffective – at the bottom or close to the bottom of all 20 ITC countries on all indicators of warning effectiveness.

We hope that the evidence presented in this report will help lead China to finally engage in designing and implementing stronger health warnings. Since the beginning of the ITC Project in 2002, we have noted many times that research evidence can give policy-makers the courage to do what’s right. In China today, as the tobacco epidemic continues unabated, there has never been such an urgent need for that kind of courage.

- Geoffrey T. Fong, PhD

Professor of Psychology and Public Health and Health Systems, University of Waterloo